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See a sample rate comparisonCPT 97799 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Unlisted Physical Medicinereh, Unlisted Physical Medicinerehabilitation Service Orprocedure Unlisted Physical Medicinerehabilitation Service Or
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 97799 |
| Medicaid Fee Schedule | $25.245 median of the 4 states in the free preview · View Medicaid rates for 97799 |
National average reimbursement for CPT 97799 by major payers:
$666.29
$47.59
$41.17
$168.30
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CPT 97799
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateRehabcare Group East, LLC, Rehabcare
$55.00Published rateDa Pediatric Rehabilitation
$55.00Published rateAll Ways Homecare Inc
$40.00Published rateBrian Dearing
Cardiology Associates Of Mobile, Inc.
$29.92Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 97799 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97799 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97799 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97537-CPT | Low | Community Work Reintegration, Community Work Reintegration Training Eg Shopping Transportation Money Management Avocational Activities And Or Work Environment Modification Analysis Work Task Analysis Use Of Assistive Technology Device Adaptive Equipment Direct One On One Contact Each 15 Minutes |
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97750-CPT | Low | Physical Performance Test, Physical Performance Test Or Measurement Eg Musculoskeletal Functional Capacity With Written Report Each 15 Minutes |
| 97799-CPT | Moderate | Unlisted Physical Medicinereh, Unlisted Physical Medicinerehabilitation Service Orprocedure Unlisted Physical Medicinerehabilitation Service Or |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97799. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97799 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a standardized set of medical codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are essential for accurate billing, claims processing, and reimbursement, ensuring a consistent way to communicate the specific procedures and services performed.
To find the specific cost of a medical procedure based on a CPT code and your particular location, you should utilize a fee schedule lookup tool. Payerprice offers a tool designed for this purpose, allowing users to search with a CPT code and a specific location to retrieve relevant fee schedule information. This empowers you to understand potential costs before receiving care.
A medical fee schedule is a comprehensive list of fees that health insurance payers use to determine the maximum amount they will reimburse healthcare providers for specific medical services or procedures. Each service is typically identified by a CPT or HCPCS code, and the fee schedule specifies the corresponding payment amount. While providers have their own charge masters, fee schedules dictate the actual payment rates from insurers.
Insurance companies determine their payment rates through a combination of factors, including negotiations with providers, analysis of regional cost data, historical claims data, and sometimes in relation to government benchmarks (such as Medicare rates). These rates are then compiled into fee schedules that specify the maximum amount the insurer will pay for each CPT or HCPCS code, which are further detailed in provider contracts.
Medical costs can vary significantly due to several influencing factors, including differences in provider overhead, equipment costs, local market competition, the specific negotiated rates between providers and insurance companies, and varying levels of service or expertise. Geographic location also plays a significant role, as labor costs and the general cost of living differ across regions. To investigate specific costs in your area, tools like Payerprice can help you compare prices based on CPT codes and locations.
To proactively understand your potential out-of-pocket costs, first obtain the CPT code for the planned procedure from your doctor. Next, contact your insurance company to clarify your benefits, deductible status, co-insurance, and out-of-pocket maximum. Finally, use a resource like Payerprice's fee schedule lookup tool, inputting the CPT code and your location, to estimate the actual costs charged by providers and what your insurer might cover, enabling you to compare prices and plan your finances accordingly.